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APPENDIX B
Pages 141-155

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From page 141...
... Q Instruction Sheet for Short Form -- Forw D-3(x)
From page 142...
... This form ,s read by a computer Black pencil ,s better pl .... wnle lhc cor,ec1 o1partmen: ,,umoo, 0 1 10.;
From page 143...
... Page 1 Question 1: Instructions: What Is the name of each person who was Lisi In Question 1 living here on Tuesday, April 4, 1978, or who was staying or visiting here and had no other • Family members 111,inghere mciud1ng b..tb1esstill home? in the hospital • Relatives living here • Lodgers or boarders l!
From page 144...
... Mexican or Chicano 1 Other Spanish Mex.an or Chic:ano : Othe
From page 145...
... 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 ~, -- , 12 3" 567 80,more ~ 1 l 2 3 4 5 15 7 Sormore _, ~ 1.... 1 2 3 4 5 6 7 ao,more ,,..,, ~ («l#Hfflic ,,_, 1 2 3 4 5 6 7 8 Of more l (_· -- -- NIVS attended school - Sltlp quallon 10 • -- -- -4 -- -- - Never attended tchool - Sltip quot/on • -- -- -~ -- -- 10 Never attended tehoot - SltJp quatkNr 10 • -- -- -- -- - Newr attended school - Slilp quadon 10 I • ___ __, Now attending th11gride (or~)
From page 146...
... IOU own or Oft buylnf No hou11 or • t:Ondonunl-um WWI Wn1t1 Black or Negro : _,,.., Asian tnchan lit UN ltom, oddras to rw.porttlw pa,;on too CfflSU'J toHr. Whit 11lhe Yllut of this property, 1h11 ii, how 9 I No much do you think lhio property (houa ond lot o, ~ ~ Guamanian 6 Chlnlll I I ...,Samoon condominium unit)
From page 147...
... 5 J 5 No , connected to sap\lC tank Of ampool No bathroom, or only I half bithroom G (, No, u,e other fflNnS 1 complete bathroom •· .• 1 comple te bolthroom, ~us half bith(a) 2 o, more comple le bathrooms ' )
From page 149...
... Pages 6-7 of the form (shown on pages 150151) are for person 1.
From page 150...
... ,o ro 2Sc. - -- - - - - - porson live ftw ,,_,.
From page 151...
... in the car, truck, CK van Ian week1 3 • 2 2 1 3 Count peJd ..utbt, paid Sid l.w, end mllltory Sffilkt.
From page 152...
... Name ot person1s11c11out anjj reason : Fqr ell:ampte . iyou may have forgotteri lo till all the necessary circles on work or on income tor a housewife, a teenager going to -scl'lool.
From page 153...
... 0 Use this ' Instruction Sheet This sheet gives helpful information on filling out your census form. If you need more help, call the local U.S.
From page 154...
... • Thtrt may bt , qulllion you cannot a-r exactly. For example, • If thtrt art more than - people in your hCIUllhold,pl- list you might not know the 1111of an elderlyperson or the price for all th• p11111ns in quntion 1, compl1t1th• form for - people, which your house would sell.
From page 155...
... If th1 penon's only m•rri1g1- annullld, mark NMr married. parsonage,a house or apartment provided free of rent by the owner, or a house or apartmentoccupiedby a janitoror caretaker in exchangefor servicn.


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